Quality breast documentation outcomes are based on three variables. The first variable is the patient candidacy for the procedure. The second variable is the choice of implants in regards to size shape and type. The third variable is the surgeons ability to place the implant and the correct anatomic position. From your pictures, I would say you are an almost perfect A+ textbook candidate for breast documentation. You have minimal breast ptosis, your nipples point forward with minimal to no divergence, and your breast sit fairly evenly on your chest wall. For most individuals, the left breast tends to sit slightly higher than the right side. This may be true for you as well, if you look at your inframammory folds. Implant selection is best done with your provider. Different plastic surgeons have very different ways of guiding patients through implant selection process. I did not find that putting implants in your bra is a very accurate way of terminating implant size. My personal preference is always been to use before and after pictures of previous patients who had very similar body characteristics to the patient having the procedure. I usually have patience go through hundreds of before and after pictures and bring in examples that they think are perfect. Bring those pictures with me to the operating room and during surgery I use temporary sizers to determine what size implant will give the outcome. The patient has described. I find it talking about inches, cup size or anything like that to be subjective and inaccurate. I typically have a full selection of implants available in the operating room and select the implants based on what size gives the desired outcomes using temporary sizers. To me, this has been the most accurate way of making the decision. I think the surgeon has far more experience and it’s in a better position to make the final decision though obviously, there has to be an element of trust and surgeons have to take ownership and responsibility for the final decision. Most plastic surgeons will tell you that women tend to be a little cautious and often wish they went bigger After primary augmentation. Women who know they only want to have a modest increase should be listened to. The volumes you mentioned are fairly conservative. All of this said my personal preference would generally be using implants that are far smaller than what most patients want. I generally go what patients ask for unless it seems excessive. Using excessively large implants will definitely Lead to higher undesirable side effects, increased, complication rates, and increased revision rates. I generally used the breast diameter to make my initial decision regarding implants. I generally stay away from high profile implants unless the patient wants a bigger implant. The choice regarding projection or profile should be based on how large the patient wants to go. Generally, low profile implants look more natural. my personal preference is to leave the implant covered by as much pectoralis muscle as possible. Still allowing the implant to sit low enough to not leave it riding high long-term. Keeping adequate pectoralis muscle support protects the implant from long-term bottoming out. Implants bottom out is a common undesirable side effect from violating the natural breast periphery, especially the infra-mammory fold. And that sense I’m not a big fan of the dual plane approach. I recognize that you have surgery coming up pretty soon, so I don’t want to stir the emotional pot. That said, I generally recommend patients have multiple in person consultations before selecting providers. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patient who had similar body characteristics to your own. An experience provider should have no difficulty showing you before and after pictures of at least 50 previous patients. Highly experienced surgeons should have access to hundreds or preferably thousands of before and after pictures. Being shown a handful of pre-selected images, representing all the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like, or how many of these procedures they’ve actually done. I also recommend patients ask providers what their most common reason for revision surgery is, what their revision rates are, and especially what their revision policy is. I would even go as far as asking providers how often they see breast implants bottom out after the procedure. This one single outcome complication seems to be the most prevalent, and can be difficult to correct later. There’s no correct number of consultations needed to find the right provider. The more consultations patient schedule the more likely they are to find the better provider. Hopefully you feel comfortable with your provider at this point and if you have questions regarding implant size, I suggest you direct them to your provider. I don’t think it’s appropriate for us to tell you what implant size to use. I wouldn’t want other plastic surgeons, telling my patients what implants to use as well. I will again mention that anatomically you are a textbook perfect candidate for breast documentation. A lot of women do not recognize that they have significant breast divergence, and this is often amplified with the projection from implants. In the hands of the right provider, you should look forward to a stellar outcome. Finally it is always safer and a better long-term strategy to not go too big on breast implants. This is true when making your primary decision, and it is even more true, when patients contemplate having increased size revision surgery in the future. Good luck with your upcoming procedure. Best, Mats Hagstrom, MD